Have you been troubled by unpleasant thoughts or images that repeatedly enter your mind, such as...

1. Concerns with contamination that may include dirt, body fluids, germs, disease, environmental contaminants or household chemicals.
   Yes No


2. Worried about losing control (i.e., harming oneself or others, blurting out obscenities or stealing items).
   Yes No


3. Troubled with being responsible for something terrible happening.
   Yes No


4. Bothered with evenness, exactness or order.
   Yes No


5. Concerned with unwanted sexual thoughts.
   Yes No


6. Excessive concern with religious obsessions.
   Yes No

Have you felt drive to perform certain acts over and over again, such as...

1. Washing or cleaning excessively or in a certain way.
   Yes No


2. Constantly checking that you performed a behavior in a certain way.
   Yes No


3. Repeating routine activities, body movements, behaviors, rewriting or rereading.
   Yes No


4. Mental review of events or praying to prevent harm.
   Yes No


5. Counting while performing a task to end on a "good", "right", or "safe" number.
   Yes No


6. "Canceling Out" or "Undoing" (example: replacing a "bad" word with a "good" word to cancel it out).
   Yes No


7. Collecting items which results in significant clutter in the home.
   Yes No


8. Avoiding situations that may trigger your persistent thoughts.
   Yes No